By Regina Hampton, MD

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Mammogram: Suspicious Mass, What’s Next?

The American Cancer Society recommends that every woman start getting a mammogram at age 40 (exceptions will be addressed in a future article).  You do your breast self-exams every month and have had mammograms every year for the last five years.  This year is no different except you receive a letter that states: “…a suspicious finding was found on your mammogram, please see your physician for evaluation and biopsy.”

Your blood pressure elevates, and you are frantic. What should you do?

First take a deep breath.  Eighty percent of breast biopsies are non-cancerous.  The next thing to do is to call your primary care physician or gynecologist and ask for a referral for a biopsy.  A biopsy takes a sample of the area in question and is usually performed by a radiologist or a surgeon.

Two types of biopsies can be performed:  minimally invasive (also known as percutaneous) and open surgical biopsy.  The standard of care is to first perform a minimally invasive biopsy. If you are offered an open surgical biopsy as your first option, you should seek a second opinion.

There are two types of minimally invasive breast biopsy methods:  ultrasound and stereotactic.  These procedures can be performed in a radiology suite or a physician’s office.  Both are performed under local anesthesia. If you have a mass that can be felt (palpable) by your physician, then an ultrasound guided biopsy is the method of choice.  If the mass is not palpable or there are calcifications seen on your mammogram, then a stereotactic breast biopsy if performed.

For an ultrasound-guided biopsy, you lay on your back with your arm placed above your head.  An ultrasound will be performed in order to confirm the location of the mass.  The area will be numbed with local anesthesia, a small cut made on the skin and a biopsy device will be inserted into the breast, and samples of tissue will be removed.  If you are having a stereotactic breast biopsy, you will lay face down on a table that has a hole in it.  Your breast will come through the hole.  You will be placed in compression (similar to your mammogram) and images will be taken in order to confirm location of the mass.  When the mass is localized, the procedure proceeds in the same manner as described above.

Upon completion, pressure will be applied to stop any minor bleeding and an ice pack can be used to decrease swelling.  The results from the biopsy take up to 1 week to return from the lab.  Be sure to discuss the results with your primary care physician or surgeon.

It is my hope to alleviate some of the fear that goes along with hearing that you have a mass on your mammogram.  It is important not to delay the biopsy.  Your chance of survival and cure are greatest when we can diagnosis cancer at its earliest stages.

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